| NPI | 1619799962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: WA 5526-6562-7034) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |